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    Clinical Trial Results:
    Multicenter, randomized, non-comparative, open-label phase II trial on the efficacy and safety of the combination of bevacizumab and trabectedin with or without carboplatin in adult women with platinum partially sensitive recurring ovarian cancer.

    Summary
    EudraCT number
    2012-003866-42
    Trial protocol
    IT  
    Global end of trial date
    15 Mar 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2022
    First version publication date
    13 Jul 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    IRFMN-OVA-6152
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Istituto di Ricerche Farmacologiche Mario Negri
    Sponsor organisation address
    Via Mario Negri 2, Milan, Italy, 20156
    Public contact
    Laboratorio di Metodologia per la Ricerca Clinica , Istituto di Ricerche Farmacologiche Mario Negri, 039 0239014684, eliana.rulli@marionegri.it
    Scientific contact
    Laboratorio di Metodologia per la Ricerca Clinica , Istituto di Ricerche Farmacologiche Mario Negri, 039 0239014686, eliana.rulli@marionegri.it
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    18 Mar 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    15 Mar 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    15 Mar 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    This study is aimed at assessing the efficacy and the safety of the combination of bevacizumab and trabectedin with or without carboplatin in adult women with epithelial ovarian cancer at first or second recurrence occurred 6-12 months after the end of the most recent platinum-containing regimen. According to the Bryant and Day design the primary endpoints will be the proportion of progression-free patients at 6 months (PFS-6) for the efficacy, and the proportion of patients with severe toxicity for the safety at the same time-point. Disease progression will be determined using the RECIST criteria, version 1.1.
    Protection of trial subjects
    NA
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    11 Jul 2013
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 71
    Worldwide total number of subjects
    71
    EEA total number of subjects
    71
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    43
    From 65 to 84 years
    28
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 71 patients were randomized or registered at 8 sites in Italy. The overall duration of the project is expected to be 48 months, divided as follows: 36 months for recruitment, followed by 12 months of treatment and follow-up for each patient.

    Pre-assignment
    Screening details
    NA

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    BT (Arm A)
    Arm description
    Patients in BT arm will receive Trabectedin 1.1 mg/m2 and Bevacizumab 15 mg/kg day 1 every 21days
    Arm type
    Experimental

    Investigational medicinal product name
    Trabectedin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trabectedin 1.1 mg/m2, bevacizumab 15 mg/kg day 1 every 21days

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trabectedin 1.1 mg/m2, bevacizumab 15 mg/kg day 1 every 21days

    Arm title
    BT+C (Arm B)
    Arm description
    Patients in BT+C arm will receive cycles 1-6: Carboplatin AUC 4 day 1 every 28 days, Trabectedin 0.8 mg/m2 day 1 every 28 days, Bevacizumab 10 mg/kg day 1 and day 15. As of cycle 7: Trabectedin 1.1 mg/m2 and Bevacizumab 15 mg/kg day 1 every 21 days.
    Arm type
    Experimental

    Investigational medicinal product name
    Trabectedin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    cycles 1-6: carboplatin AUC 4 day 1 every 28 days, trabectedin 0.8 mg/m2 day 1 every 28 days, bevacizumab 10 mg/kg day 1 and day 15. As of cycle 7: trabectedin 1.1 mg/m2 and bevacizumab 15 mg/kg day 1 every 21 days.

    Investigational medicinal product name
    Bevacizumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    cycles 1-6: carboplatin AUC 4 day 1 every 28 days, trabectedin 0.8 mg/m2 day 1 every 28 days, bevacizumab 10 mg/kg day 1 and day 15. As of cycle 7: trabectedin 1.1 mg/m2 and bevacizumab 15 mg/kg day 1 every 21 days.

    Investigational medicinal product name
    Carboplatin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    cycles 1-6: carboplatin AUC 4 day 1 every 28 days, trabectedin 0.8 mg/m2 day 1 every 28 days, bevacizumab 10 mg/kg day 1 and day 15. As of cycle 7: trabectedin 1.1 mg/m2 and bevacizumab 15 mg/kg day 1 every 21 days.

    Number of subjects in period 1
    BT (Arm A) BT+C (Arm B)
    Started
    50
    21
    Completed
    46
    20
    Not completed
    4
    1
         Major violation of eligibility criteria
    3
    1
         Intercurrent illness
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    BT (Arm A)
    Reporting group description
    Patients in BT arm will receive Trabectedin 1.1 mg/m2 and Bevacizumab 15 mg/kg day 1 every 21days

    Reporting group title
    BT+C (Arm B)
    Reporting group description
    Patients in BT+C arm will receive cycles 1-6: Carboplatin AUC 4 day 1 every 28 days, Trabectedin 0.8 mg/m2 day 1 every 28 days, Bevacizumab 10 mg/kg day 1 and day 15. As of cycle 7: Trabectedin 1.1 mg/m2 and Bevacizumab 15 mg/kg day 1 every 21 days.

    Reporting group values
    BT (Arm A) BT+C (Arm B) Total
    Number of subjects
    50 21 71
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    29 14 43
        From 65-84 years
    21 7 28
        85 years and over
    0 0 0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    60.8 (52.1 to 69.9) 59.4 (54.0 to 66.1) -
    Gender categorical
    Units: Subjects
        Female
    50 21 71
    Subject analysis sets

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    the ITT includes all subjects who provided informed consent and were randomized/registered to one of the treatment arms excluding those with any major violation of the eligibility criteria.

    Subject analysis set title
    PP
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The PP population includes all randomized/registered patients, without major violations of eligibility criteria, who have received at least 12 weeks of treatment (unless interrupted treatment for progressive disease, drug toxicity or death), and whose disease is assessed.

    Subject analysis set title
    Safety
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    the Safety population includes all subjects who provided informed consent and were randomized/registered to one of the treatment arms, who had no major violations of eligibility criteria, and who received at least one dose of treatment.

    Subject analysis sets values
    ITT PP Safety
    Number of subjects
    67
    66
    66
    Age categorical
    Units: Subjects
        In utero
    0
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
    0
        Newborns (0-27 days)
    0
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
    0
        Children (2-11 years)
    0
    0
    0
        Adolescents (12-17 years)
    0
    0
    0
        Adults (18-64 years)
    42
    42
    42
        From 65-84 years
    25
    24
    24
        85 years and over
    0
    0
    0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    60.7 (53.1 to 68.3)
    60.7 (53.1 to 67.3)
    60.7 (53.1 to 68.3)
    Gender categorical
    Units: Subjects
        Female
    67
    66
    67

    End points

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    End points reporting groups
    Reporting group title
    BT (Arm A)
    Reporting group description
    Patients in BT arm will receive Trabectedin 1.1 mg/m2 and Bevacizumab 15 mg/kg day 1 every 21days

    Reporting group title
    BT+C (Arm B)
    Reporting group description
    Patients in BT+C arm will receive cycles 1-6: Carboplatin AUC 4 day 1 every 28 days, Trabectedin 0.8 mg/m2 day 1 every 28 days, Bevacizumab 10 mg/kg day 1 and day 15. As of cycle 7: Trabectedin 1.1 mg/m2 and Bevacizumab 15 mg/kg day 1 every 21 days.

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    the ITT includes all subjects who provided informed consent and were randomized/registered to one of the treatment arms excluding those with any major violation of the eligibility criteria.

    Subject analysis set title
    PP
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The PP population includes all randomized/registered patients, without major violations of eligibility criteria, who have received at least 12 weeks of treatment (unless interrupted treatment for progressive disease, drug toxicity or death), and whose disease is assessed.

    Subject analysis set title
    Safety
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    the Safety population includes all subjects who provided informed consent and were randomized/registered to one of the treatment arms, who had no major violations of eligibility criteria, and who received at least one dose of treatment.

    Primary: PFS-6 (BT)

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    End point title
    PFS-6 (BT)
    End point description
    The PFS-6, defined as the percentage of patients who are alive and progression free at 6 months after the randomization.
    End point type
    Primary
    End point timeframe
    6 months
    End point values
    BT (Arm A) BT+C (Arm B)
    Number of subjects analysed
    36
    17
    Units: Patients
    25
    14
    Statistical analysis title
    Progression Free Survival Rate at 6 months (BT)
    Comparison groups
    BT (Arm A) v BT+C (Arm B)
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    Method
    Parameter type
    Proportion of responder
    Point estimate
    69.4
    Confidence interval
         level
    80%
         sides
    2-sided
         lower limit
    57.6
         upper limit
    79.6
    Notes
    [1] - Since the trail was non-comparative, no statistical comparison between arms was planned and performed

    Primary: ST-6 (BT)

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    End point title
    ST-6 (BT)
    End point description
    The Proportion of patients with severe toxicity within 6 months from randomization.
    End point type
    Primary
    End point timeframe
    6 months
    End point values
    BT (Arm A) BT+C (Arm B)
    Number of subjects analysed
    36
    17
    Units: Patients
    6
    8
    Statistical analysis title
    ST-6 (BT)
    Comparison groups
    BT+C (Arm B) v BT (Arm A)
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other [2]
    Method
    Parameter type
    Proportion of pts with severe toxicity
    Point estimate
    16.7
    Confidence interval
         level
    80%
         sides
    2-sided
         lower limit
    9
         upper limit
    27.4
    Notes
    [2] - Since the trail was non-comparative, no statistical comparison between arms was planned and performed

    Primary: PFS-6 (BT+C)

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    End point title
    PFS-6 (BT+C)
    End point description
    The PFS-6, defined as the percentage of patients who are alive and progression free at 6 months after the randomization.
    End point type
    Primary
    End point timeframe
    6 months
    End point values
    BT (Arm A) BT+C (Arm B)
    Number of subjects analysed
    36
    17
    Units: patients
    25
    14
    Statistical analysis title
    Progression Free Survival Rate at 6 months (BT+C)
    Comparison groups
    BT (Arm A) v BT+C (Arm B)
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other [3]
    Method
    Parameter type
    Proportion of responder
    Point estimate
    82.4
    Confidence interval
         level
    80%
         sides
    2-sided
         lower limit
    64.8
         upper limit
    93.3
    Notes
    [3] - Since the trail was non-comparative, no statistical comparison between arms was planned and performed

    Primary: ST-6 (BT+C)

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    End point title
    ST-6 (BT+C)
    End point description
    The Proportion of patients with severe toxicity within 6 months from randomization.
    End point type
    Primary
    End point timeframe
    6 months
    End point values
    BT (Arm A) BT+C (Arm B)
    Number of subjects analysed
    36
    17
    Units: Patients
    6
    8
    Statistical analysis title
    ST-6 (BT+C)
    Comparison groups
    BT+C (Arm B) v BT (Arm A)
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other [4]
    Method
    Parameter type
    Proportion of pts with severe toxicity
    Point estimate
    47.1
    Confidence interval
         level
    80%
         sides
    2-sided
         lower limit
    29.7
         upper limit
    65
    Notes
    [4] - Since the trail was non-comparative, no statistical comparison between arms was planned and performed

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    During treatment. Treatment was continued until progressive disease, major toxicity, patient’s intolerance or unwillingness to continue treatment, or at the physician’s discretion. The median number cycles was 10.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    NCI-CTCAE
    Dictionary version
    4
    Reporting groups
    Reporting group title
    BT (Arm A)
    Reporting group description
    Bevacizumab+Trabectedin

    Reporting group title
    BT+C (Arm B)
    Reporting group description
    Carboplatin+Bevacizumab+Trabectedin

    Serious adverse events
    BT (Arm A) BT+C (Arm B)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    11 / 47 (23.40%)
    7 / 20 (35.00%)
         number of deaths (all causes)
    20
    9
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute leukemia
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Left ventricular dysfunction
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Angina pectoris
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Loss of consciousness
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Seizure
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    1 / 47 (2.13%)
    3 / 20 (15.00%)
         occurrences causally related to treatment / all
    0 / 1
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Leukopenia
         subjects affected / exposed
    2 / 47 (4.26%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ascites
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Haematochezia
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 47 (2.13%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hypokalemia
         subjects affected / exposed
    0 / 47 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    BT (Arm A) BT+C (Arm B)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    39 / 47 (82.98%)
    18 / 20 (90.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    25 / 47 (53.19%)
    14 / 20 (70.00%)
         occurrences all number
    65
    65
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    22 / 47 (46.81%)
    15 / 20 (75.00%)
         occurrences all number
    44
    44
    Lymphocyte count decreased
         subjects affected / exposed
    14 / 47 (29.79%)
    5 / 20 (25.00%)
         occurrences all number
    84
    42
    Neutrophil count decreased
         subjects affected / exposed
    27 / 47 (57.45%)
    14 / 20 (70.00%)
         occurrences all number
    87
    51
    Platelet count decreased
         subjects affected / exposed
    5 / 47 (10.64%)
    16 / 20 (80.00%)
         occurrences all number
    5
    71
    White blood cell decreased
         subjects affected / exposed
    25 / 47 (53.19%)
    12 / 20 (60.00%)
         occurrences all number
    73
    64
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    32 / 47 (68.09%)
    14 / 20 (70.00%)
         occurrences all number
    102
    14
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    31 / 47 (65.96%)
    13 / 20 (65.00%)
         occurrences all number
    86
    77
    Constipation
         subjects affected / exposed
    26 / 47 (55.32%)
    12 / 20 (60.00%)
         occurrences all number
    26
    78

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    12 Mar 2015
    PRINCIPAL CHANGES: 1. INCLUSION CRITERIA -> adding an inclusion criteria 2. STATISTICAL ANALYSIS -> changes in PFS percentage in patients in both arms 3. NON SUBSTANTIAL CHANGES -> changes regarding centers, contact and text formulation 4. INSURANCE -> update of the insurance certificate 5. INVESTIGATOR BROCHURE -> update of the document 6. INFORMED CONSENT -> update of the document
    30 Jun 2016
    PRINCIPAL CHANGES: 1. TREATMENT -> closure of the treatment arm B 2. ADVERSE EVENT -> changes in text formulation regarding severe toxicity 3. STUDY POPULATION -> more details about study population 4. INCLUSION CRITERIA -> changes in one inclusion criteria 5. TRABECTEDINE -> Trabectedine dose reduction 6. ADVERSE EVENT -> changes in AE reporting 7. CONTACTS -> changes regarding study referents 8. CENTERS -> adding a clinical centre 9. DATA PROTECTION FORM -> update of the document
    01 Feb 2018
    PRINCIPAL CHANGES: 1. INVESTIGATIONAL MEDICAL PRODUCT2 -> changes of the certified site for the release of IMP2, Bevacizumab (AVASTIN)

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/31537908
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